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age of breast cancer screening should be reduced to address health disparities: petition

led by undergarment company, love & nudes, the petition recommends breast cancer screenings start at 40, not 50, in recognition of studies that have shown black women are disproportionally affected.

by emma jones
published jan 27, 2023
last updated feb 16, 2023
read time 4 minute read
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read time 4 minute read
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are canadian breast cancer screening guidelines equitable?
black women in the u.s. have a 40 per cent higher mortality rate from breast cancer but a four per cent lower incidence rate of developing the cancer, according to the american cancer society. supplied
a new petition is recommending the government of canada change the age of routine breast cancer screenings from 50 to 40, in recognition of studies that have shown black women are disproportionally affected by early-onset forms of the cancer. the petition, led by love & nudes, an undergarment brand catering to women of colour, was launched at a panel discussion where founder chantal carter also introduced a line of bras that look and feel how breast cancer may present in a range of skin tones.
“we need to bring [breast screening] down to 40. why? because breast cancer does not just affect women in their 50s — women in their 40s also have breast cancer,” charmain emerson, communications strategist and founder of black opportunity fund told attendees. “ … we’re here today specifically because black women are disproportionately affected by a rare form of breast cancer, and that is the triple-negative onset.”
triple-negative breast cancer is negative for estrogen and progesterone receptors and produces little-to-no her2 protein, making it “triple negative” for these diagnostic tests. it is also more likely to appear in women under the age of 40. when it is discovered, it has often already spread (metastasized), likely due in part to its aggressive nature at an age before most women undergo routine breast screening.

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dr. jean seely, a professor of radiology at the university of ottawa, is calling for women age 40 and up to get regular mammograms.
in 2021, more than 27,000 women in canada will be diagnosed with breast cancer, the canadian cancer society says. getty

dense breasts should mean annual mammograms
most women aren’t aware they have dense breasts or that it’s a risk factor for cancer.
some health jurisdictions are offering annual mammograms to women with denser breasts.
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when it does spread, the triple-negative subtype is found in the brain, lungs or bloodstream more often than other forms of breast cancer. and while triple-negative breast cancer does respond to chemotherapy, it is more likely to reoccur after treatment.
according to the canadian cancer society, “women under the age of 40 and women of african or asian ancestry have a higher risk of developing triple-negative breast cancer.” a study of 198,278 women aged 40 to 84 from the perelman school of medicine at the university of pennsylvania also found that black women had 2.7 times higher risk of developing triple-negative breast cancer.
in 2022, the american cancer society published data which found that in the u.s., black women have a 40 per cent higher mortality rate from breast cancer but a four per cent lower incidence rate of developing the cancer.
other groups have also called for the reduction in age for breast cancer screening. a study published last year in the journal of medical screening raised questions about the validity of the study that the current mammogram guidelines are based on. the authors of the paper, including dr. jean seely, professor of radiology at the university of ottawa and head of breast imaging at the ottawa hospital, called for mammograms for women aged 40 and up.
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breast cancer canada
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in a statement to healthing, breast cancer canada also supported the reduction in age for breast cancer screening, noting that not only is early onset breast cancer a concern in canada, but rates are increasing.
“the incidence of early onset breast cancer over the past 20 years has been on the increase with well documented evidence and literature,” the statement reads. “beyond the known racial inequities and improvements in knowledge for genetic risk, there are many factors still to be determined as to why we are seeing a rise in early onset breast cancer
“…we should be utilizing the screening infrastructure we currently have to allow the option of public covered screening in women at a younger age, based on a discussion with their care provider about known risk factors for [early-onset breast cancer].”
‘love & nudes’ has introduced a series of models that look and feel how breast cancer may present in a range of skin tones. supplied
‘love & nudes’ has introduced a series of models that look and feel how breast cancer may present in a range of skin tones. supplied

more data is needed to understand health disparities in canada

in canada, there isn’t much data on health status and outcomes based on ethnic group, bukun adegbembo, manager of operations for the canadian breast cancer network explains through email. while it’s likely that trends are somewhat similar to the united states, it’s not a direct comparison.
according to a review of 2,000 studies published between 2003 and 2018 on cervical and breast cancer in canada, only 23 of them focused on black canadians, according to the canadian breast cancer network.
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adegbembo pointed to the canadian breast cancer network’s blogpost the myth that cancer does not discriminate, which reads “ … limited data means that inequalities can’t be properly addressed which contributes to systemic racism in the canadian health care system.”
breast cancer was the most-diagnosed cancer in females for all ethnicities, according to a statistics canada report based on data from the 2006 census. the authors found that “breast cancer mortality was highest among european females and lowest among lcsa [latin, central and south american] females,” based on data comparing canadians of european, non-indigenous north american, east asian, south asian, african, west-central asian and middle eastern, belonging to the caribbean group, and lcsa descent.
more information that considers the diversity of canadians is needed to develop more informed practices, according to a statement from elizabeth holmes, senior manager of policy and surveillance of the canadian cancer society. “it needs to be real-time data that is complete, representative, and disaggregated. this requires collaboration to enhance current data collection and reporting, especially for improving race-based data.”
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improved data means better, more effective diagnoses and treatment options for patients.
“when we say black, it’s not a monolith,” mojola omole, md, general surgeon and breast surgical oncologist at the scarborough health network, said at the love & nudes panel. “ … i’m nigerian. i’m described as black, but so is someone who’s from somalia or kenya, but they actually have vastly different subtypes of breast cancer.”
“it’s important we’re inclusive when we talk about this.”
 
emma jones is a multimedia editor with healthing. you can reach her at emjones@postmedia.com or on instagram and twitter @jonesyjourn.
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